Sleep and Menopause Research

Hot flashes are depicted as a sensation of heat, sweating, flashing, anxiety, and chills lasting one to five minutes and are reported by up to 84% of women in natural menopause. A hot flash is a heat-dissipation response, consisting of peripheral vasodilation, and sweating beginning in the upper part of the body. We believe that in the absence of estrogen, the hypo-thalamus becomes more sensitive to core body temperature changes over a much narrower temperature range.

Perimenopausal women were recruited from the San Francisco Bay area community over a four-year period. Women included here were participating in an ongo-ing study about sleep quality during the menopausal transition Thirty-four women (Age, mean±SD: 50.4±2.7 years; BMI, mean±SD: 24.3±3.6 kg.m; 23 white) met inclusion criteria and were included in the analysis.

Upon awakening in the morning, women completed sleep and hot flash questionnaires. They reported the number of perceived awakenings (Awakenings), wake after sleep onset (WASO, min), and sleep quality on a 100 mm visual analogue scale, ranging from 0, “very bad”, to 100, “very good” (SQ), as used elsewhere. They also were asked to report the number of nocturnal hot flashes experienced (HF-number) and how bothered they were by hot flashes/night sweats during the night (HF-bother), as used elsewhere.

The authors found that hot-flash associated wake time accounted for, on average, 27.2% of PSG-defined wakefulness during the night in peri-menopausal women.

In another study published in the Journal of Endocrinology and Metabolism when women were awake long enough to recall nighttime hot flashes, that perception contributed to mood disturbances and anxiety.

I believe the take home message here is that we need to screen our peri-menopausal and post-menopausal patients who present with moodiness and anxiety for sleep disturbances. The incidence of insomnia as well as sleep apnea increases remarkably during the menopause.

There are many available options for hot flashes. Effective therapies include low dose estrogen, gabapentin, SSRI and SSNRIs such as paroxetine and venlafaxine as well as Lunesta (eszopiclone) which in a recent study was found to be effective in menopausal hot flashes. In fact, a simple behavioral technique of lowering the thermostat works for some.